New Study: “Obstructed Labor and Caesarean Delivery: The Cost and Benefit of Surgical Intervention”

Posted on April 26, 2012

In Rwanda, a mother receives an ultrasound during her final trimester.

Each year, nearly 273,000 women die from complications during pregnancy and childbirth. Ninety-nine percent of these deaths take place in the developing world and nearly all of them are preventable.

A new study published on April 25, 2012, in the medical journal PLoS One, finds that investing in the training and infrastructure needed to provide simple surgery such as Caesarean delivery can not only save lives, but is a highly cost-effective and economically viable tool for improving global health.

“Of course, those of us whose patients have died for want of this basic surgical intervention have long known of the terrible cost—not just to the women and their families, but to the communities and whole countries which bear the greatest burden of preventable death and illness,” said Paul Farmer, PIH co-founder, and co-author of the study.

By performing 2.8 million additional Caesarean deliveries for obstructed labor in 49 of the worlds poorest countries, Meara projected that 16,800 mother’s lives would be saved. Many other women would be spared lives with chronic disabilities such as obstetric fistula, an abnormal communication between the vagina and the rectum following difficult labor.

According to the study, the median cost of each surgery is $141, and the median cost to avert the loss of a healthy year of life is $304. On average, for every $1 invested in providing the surgery, $6 of economic value are earned by preventing deaths and disabilities.

“Although one might arrive at this position solely based on human rights theory, our study suggests that surgery can also be highly cost-effective and a good economic proposition,” said Meara.

“The conclusion is straightforward: surgery, or more specifically in this case, Caesarean delivery, is not a luxury that should be reserved for the developed world,” said Blake Alkire, co-author and clinical fellow in surgery at Brigham and Women’s Hospital.

Paul Farmer goes on to point out that, although surgical disease remains a ranking killer of the world’s poor, surgery is “the neglected stepchild of global health.”

“As this study makes clear, these are not only ‘stupid deaths,’ as is said in Haiti (which has the highest maternal mortality rate in our hemisphere), not just tragedies, but tragic misallocations of resources, ” continued Farmer.